Tom Eblen: Mini-internship program offers close-up look at doctors' world

I'm not a doctor, and I don't play one on TV. But I did spend two days last week shadowing doctors and talking with them about what they do and the environment in which they do it.

I was one of seven people who participated in the Lexington Medical Society's Mini-Internship Program. Since 1994, nearly 30 groups of community "interns" have been given a two-day, close-up look at the working lives of physicians.

One of the things I have always enjoyed about being a journalist is exploring other people's worlds. Journalism is a license to be nosy, ask questions, observe others, and discuss issues with people who have unique expertise.

That's how I found myself in a locker room at Central Baptist Hospital, changing into scrubs so I could spend the morning in an operating room. I watched as Dr. Kaveh Sajadi, a second- generation orthopedic surgeon, performed shoulder replacements on two patients suffering from severe arthritis pain.

With help from a skilled team, Sajadi replaced two worn ball-and-socket joints with precisely fitted new ones made of high-tech metal and plastic. If you assume this is a difficult and messy process, you would be correct. But for Sajadi and his team, it was a well-choreographed ballet.

Sajadi explained each step of the operation as I stood and watched from a distance. I had to sit down a couple of times when my knees got wobbly. But soon I was able to focus on the miracle of medicine taking place before my eyes rather than, well, you know.

I spent the afternoon with Dr. John Kitchens, an ophthalmologist who specializes in the retina, the light-sensitive tissue that lines the inside of eyes. Digital imaging technology allows him to find and treat microscopic leaks in blood vessels that can reduce a person's vision.

His most common treatment that day was injecting medicine into eyeballs. It was a process slightly painful for the observer, though not the numbed patient. But after watching shoulder- replacement surgery, I was ready for anything.

Kitchens was a busy man, dashing from one examining room to another. But he never seemed rushed when he was with patients. He carefully explained diagnoses and treatment options. He even took time to ask about patients' families, impressively recalling many personal details about people he had seen before.

I spent the next morning in St. Joseph Hospital's emergency room with Dr. William Wooster, an emergency-room veteran who has seen it all, sometimes in the same day. But this was a slow morning. A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth.

Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms.

I spent that afternoon making rounds at Central Baptist Hospital with Dr. Andrea Lyons, an internal medicine "hospitalist." The young mother of two examined patients — many of them elderly and sick with a variety of issues — and worked to coordinate care with their primary physicians and specialists.

Those two days confirmed several things I already knew: Doctors have demanding jobs and exhausting schedules. They spend a lot of time updating and consulting patients' medical records. They depend heavily on nurses, other skilled professionals and staff. And they care deeply about their work.

Like everyone else, the doctors I met had a variety of opinions about health care reform. But they all said the nation will never curb rising costs without legal tort reform. Fear of lawsuits forces physicians to pay huge sums for malpractice insurance and practice costly "defensive" medicine.

As I shadowed these physicians, I kept thinking how much of their patients' pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse.

I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs.